Gynecology, Obstetrics and Perinatology

Preeclampsia today: pathogenesis and possibilities of prognostication and treatment

The review discusses from modern positions the pathogenesis of preeclampsia that is one of clinical manifestations of «great obstetrical syndromes». Their development is conditioned by impaired placentation, insufficient gestational restructuring of spiral arteries. These pathological changes decrease placental perfusion, О2 concentrations in the intervillous, which stimulates the trophoblast cells to produce both angiogenic and antiangiogenic factors. Their imbalance launches a systemic dysfunction of the endothelium, vascular spasm, conditioning clinical manifestations of PE. At present, it is expedient to single out early and late preeclampsia that differ in both time of the onset and predisposing factors, clinical course, possibility of prognostication and severity of morphological changes in the placental bed. Molecular medicine offers currently established weighty evidence for existence of PE biomarkers – placental growth factor, vascular-endothelial growth factor, endoglin, inhibin. In combination with biophysical parameters they permit to prognosticate the development of early PE. Future research directions of prognostication and prevention of PE should be based on revealing and specifying PE subtypes taking into account the influence of maternal constitutional factors for stratification of patients based on specific biomarkers for subsequent individual target preventive and therapeutic strategies.

Key words: early and late preeclampsia, KIR receptor, decidual NK cells, placental growth factor.
 
For citation: Strizhakov A.N., Timokhina E.V., Pitskhelauri E.G., Belousova V.S., Yakushina N.I. Preeclampsia today: pathogenesis and possibilities of prognostication and treatment. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2016; 15(3): 24–31.
DOI: 10.20953/1726-1678-2016-3-24-31

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